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I.
PREVENTIVE POLICIES ON INFANT FEEDING: to mitigate emergencies and
for general child survival, growth and development:
-
Breastfeeding
should be initiated within the first hour after birth
-
Exclusive
breastfeeding protected and supported for 6 months
-
Continue
breastfeeding up to 2 years and beyond.
-
Complementary
feeding – which “tops up” human milk - starts from 6 months of
age and continues to 2 years and beyond as child becomes more
able to eat family foods.
Suggested actions: Implement the Global Strategy for Infant and Young Child Feeding (see
Exec Dir 04-022 and related guidance) - Support:
-
National
policy and Code law;
-
Health system
support for Baby-friendly, curriculum updates and data
collection;
-
Community
mobilization for support of breastfeeding and complementary
feeding;
-
Attention to
special issues of HIV/AIDS and emergencies.
ll. INFANT
AND YOUNG CHILD FEEDING IN EMERGENCY SETTINGS:
UNICEF has a
Core Corporate Commitment in the first 6-8 weeks of an emergency to
“Provide
child and maternal feeding and nutritional monitoring:
support infant and young child feeding, therapeutic and
supplementary feeding programs with WFP
and NGO partners. Introduce nutritional monitoring and
surveillance.” These activities should continue after 8 weeks as
well.
As
the lead UN Children’s Agency, this area remains UNICEF
responsibility no matter which agency is the lead.
Suggested
actions:
A. Immediate attention must be given to the
protection and
support for breastfeeding, especially exclusive breastfeeding.
1.
This includes:
a. Support: immediate establishment of “safe havens”,
or safe spaces, where stress is reduced, counseling provided, and
appropriate rations and water can be assured for pregnant and
lactating women. Also, ensure
that pregnant women have access to iron/folate supplementation
and iodized salt (or supplements).
b.
Protection: follow guidance to stop acceptance in emergencies
of powdered milks or other breastmilk substitutes. Donations of
powder milk carry special concerns. Given poor infrastructure and
living conditions in emergencies, and in other settings in need, all
necessary measures must be taken to ensure the safe use of any
donation.
Lack of potable water, lactose-intolerance, and bacterial
growth that occurs in powdered milks or formulas may result in
increased risk of diarrheal disease and increased
risk of fatalities amongst children.
c.
Lactation maintenance and relactation support: skilled workers
should be made available to ensure support, protection and
relactation. “Supplementer” devices should be provided that
allow supplementation during suckling.
2.
Concerning donations of breastmilk substitutes
-
Donations of powder milk carry special concerns.
There are at least 4 reasons that powdered milks and formulas
remain dangerous in emergencies, even with trained staff:
-
In
populations with lactase-deficiency (most developing country
settings), a sudden increase in milk as a percentage of
intake can cause diarrhea in infants, children and adults.
-
Milk
powders and prepared milks can serve as growth media for
bacteria. Where storage is not optimal, there can be rapid
increases in contamination of all sorts.
-
Where there
is no guarantee of potable water for mixing or cleaning, or
sterile water for younger infants, formula preparation and
feeding cannot be carried out safely.
-
If powdered
milks or formula are used to replace or substitute for
breastmilk, the child loses protection against disease that
is gained from breastfeeding, and the family becomes
dependent on artificial feeding, with all its costs and
risks.
-
Donations of breastmilk substitutes,
infant formula, bottles and teats should be refused.
-
Dried skimmed milk should not be
given as a single commodity or as part of a general food
distribution, because of the risk that it will be used as
breastmilk substitutes.
-
Ensure that there are available
rations that may be used for complementary feeding for breastfed
children 6 months to 2 years. These rations may include milks
mixed with a milled staple food.
-
Every effort should be made to place
unaccompanied young children with family or foster care.
Infant formula should be used only under strict conditions,
when:
-
Lactation status of mother has
been assessed, in the case where relactation is not possible
-
An HIV-positive mother has
chosen not to breastfeed.
-
Children no longer have access
to breastmilk, e.g. orphaned children, unaccompanied
children, etc, and where there is assurance of supply of
infant formula or as long as the infant needs it.
-
Infant formula can be provided
under close supervision, monitoring, and follow up by
trained health staff, and mothers/caretakers are provided
with adequate information and counseling on safe preparation
of infant formula and appropriate infant feeding practices.
3. Special concerns:
-
Infant formula must meet the
International Code and Codex Alimentarius standards, including
labeling and language standards.
-
Condensed milk and UHT milk (liquid)
cannot be provided to infants less than 12 months of age.
-
Bottles and teats should never be
distributed, and their use should be discouraged. Feeding should
be done using a cup.
4. To reduce the danger of artificial feeding, the following conditions
should be met:
-
Easily cleaned
cups, and soap and clean water for cleaning them
-
Clean surface
and safe storage for preparation
-
Means of
measuring water and milk powder (not a feeding bottle)
-
Adequate
fuel and potable water (if possible and available, use bottled
water)
-
Home visit to
lessen difficulties in preparing feeds
-
Follow up with
extra care and supportive counseling
-
Continued
promotion for breastfeeding to prevent spillover of infant
formula use to those mothers still able to breastfeed
B.
Support for continued breastfeeding with complementary
feeding:
Suggested Actions:
1. Ensure that there are available rations
(quantity and
quality) that may be used for
complementary feeding
for breastfed children 6 months to 2 years. These rations may
include milks mixed with a milled staple food. (See section 6.2 of
Annex 1: Infant and Young Child Feeding in Emergencies, appended and
at
http://www.ennonline.net/ife/ifeops.html)
2. Nutrition education on safe preparation and storage of
complementary foods prepared from locally available
foodstuff should
be initiated as soon as feasible.
3. Support continued frequent, responsive breastfeeding.
C.
Support therapeutic and supplementary feeding programs
with WFP and NGO partners.
Suggested actions:
Establish therapeutic feeding programs (both
within health facilities and community-based)
and provision of related supplies and equipment and staff to run the
therapeutic feeding centers
(This WHO manual
is in the process of update)
http://www.who.int/nut/documents/manage_severe_malnutrition_eng.pdf
WHO- and
UNICEF-approved Infant Feeding in Emergencies, Modules 1 and 2
Version 1.0, for health and nutrition workers in emergency
situations.
http://www.ennonline.net/ife/module2/m2pdf/m2annexes.pdf
D.
Related activities:
1.
Provide nutrition education materials in collaboration with other
partners including the elaborating standard IEC materials and
methods.
2.
UNICEF will support capacity building on caring practices through
training of institutional caretakers/health workers or others
lll. FALSE MYTHS
AND RESPONSES
Myths about
breastfeeding can undermine both a mother’s confidence and the
support she receives. The five most common myths are:
A. “Stress makes
milk dry up”
While extreme stress or fear may cause milk to stop flowing,
this response, like many other
physiological responses to anxiety, is usually temporary and
milk flow will generally resume
when stress is
reduced.
Safe havens/spaces
for lactating women, where they can be sure to receive
water and rations for themselves, and help their sisters
relactate as needed, is the best
intervention. When milk flow is supported, breastfeeding will
also produces hormones that
reduce tension, calm the mother and the baby and create a
loving bond.
B. “Malnourished
mothers cannot breastfeed”
Food should go to
the lactating mothers so that they can feed their babies and
maintain the strength to care for older children in the family as
well. In the case of severe malnutrition, the use of breastfeeding
supplementers (devices that allow supplements to be delivered while
the infant sucks at the breast) can be used to overcome the
malnutrition while ensuring increased breastmilk production.
C. “Babies with
diarrhea need water or tea”
As breastmilk is
about 90% water, exclusively breastfeeding babies with diarrhea do
not usually need additional liquids such as glucose water or tea.
What is more, water is often contaminated in emergency situations.
In the case of severe diarrhea however, oral rehydration therapy
(administered by cup) may be required, besides breastmilk.
D.
“Once
breastfeeding has stopped, it cannot be resumed”
With an adequate
relactation technique and support, it is possible to help mothers
and their babies to restart breastfeeding after they have switched
to infant formula. This is vital in emergency.
**Feeding Infants
Under Six Months in Emergencies: a Triage Approach to
Decision-Making
**
Added by Wellstart from The Emergency Nutrition Network
This
page was updated:
07/17/2007
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